The aim of this Mentored Patient-Oriented Research Career Development Award (K23) application is to provide a period of mentored research and career development activities, which will assist me in my long-term goal of becoming an independent investigator in the area of women's contraceptive decision making. I propose an innovative research project using a web-based contraceptive decision aid to help inform women's decision- making processes. My proposed career development plan will allow me to meet my following short term goals: pursue continued training in research methodology; acquire new skills in qualitative research methods, shared decision making, and decision analysis; and acquire skills to design and conduct randomized clinical trials. These skills will be essentially in learning to effectively plan, implement, and analyze studies in contraceptive decision making. I will collaborate closely with mentors experienced in patient-oriented research to facilitate completion of this project. Washington University School of Medicine has excellent clinical research infrastructure and the diverse and multidisciplinary academic community fosters scholarly investigation. Additionally, there are resources required to succeed in this project are available to me including Masters level courses in research methods. Unintended pregnancy continues to be a significant public health problem in the United States despite the fact that more than 60% of women currently use contraception. Contraceptive counseling is an important mediator of contraceptive selection and use, but there is little data to indicate what constitutes effective contraceptive counseling. An intervention which improves patient education and counseling has the potential to improve contraceptive use. Patient decision aids have been successfully employed in other areas of healthcare decision making and have been shown to result in increased knowledge, more realistic expectations, and decreased decisional conflict. In this innovative study, I propose to evaluate, refine, and test a web-based contraceptive decision aid. My specific aims are to: 1) refine a contraceptive decision aid and evaluate ease of use, understandability, and ability to clarify the values and preferences that influence women's contraceptive decisions; 2) build an algorithm within the decision aid that effectively narrows the recommended contraceptive options to methods that reflect the woman's unique contraceptive preferences; and 3) compare the effectiveness of a contraceptive decision aid on reducing decisional conflict compared to women undergoing usual contraceptive counseling in a randomized clinical trial. This project is novel in its focus on a web-based contraceptive decision aid which incorporates women's values and preferences in contraceptive decision making. Additionally, the decision aid will incorporate an algorithm which will recommend contraceptive methods based on these values and preferences. We will evaluate the primary outcome of decisional conflict, which has been used in multiple clinical trials of patient decision aids to measure the effectiveness of decision aids. If successful, this intervention will improve contraceptive use by improving contraceptive knowledge, satisfaction with contraceptive method chosen, and decreasing decisional conflict. This has the potential to significantly impact the rates of unintended pregnancy. PUBLIC HEALTH RELEVANCE: Unintended pregnancy is a common problem in the United States. There are multiple methods of reversible contraception available; however, it is not clear how women decide which method to choose. This career development award proposal will evaluate, refine and test a decision aid to help women effectively choose contraceptive methods.